Extracorporeal membrane oxygenation to support repeated whole-lung lavage in a patient with pulmonary alveolar proteinosis in life threatening dyspnoe – a case report

Abstract

BackgroudPulmonary alveolar proteinosis is a rare disorder that is characterized by a large accumulation of lipoproteinaceous material within the alveoli. This causes respiratory failure due to a restriction of gas exchange and changes in the ventilation/perfusion ratio. Clinical symptoms are variable and depend on the severity of damage of the lung parenchyma. Treatment method is whole-lung lavage, where the accumulated lipoproteinaceous material is removed using large quantities of saline.Case presentationThis case report describes a 45 year old patient with advanced pulmonary alveolar proteinosis. Due to the presence of severe global respiratory insufficiency, this patient could not undergo the classic whole-lung lavage using a double-lumen tube and selective lung ventilation. The whole-lung lavage was performed with the support of veno-venous extracorporeal membrane oxygenation. A total of 27 l of warm saline was used.ConclusionAccording to the current published literature, whole-lung lavage with extra-corporeal membrane oxygenation support is a very rare treatment method. Even when taking into account all of the risks associated with whole-lung lavage and v-v extracorporeal membrane oxygenation support, we found that this technique is very effective and, without a doubt, it saved the life of our patient.

Pulmonary alveolar proteinosis: a case report

“…It announced that PAP patients who have bad general status, need of ventilation, have good results with extracorporeal membrane oxygenation (ECMO) support lung lavage [15]. However, our center has not ECMO background so we could not support the patient with ECMO.…”

Lavado pulmonar total bilateral en una sola sesión bajo ECMO veno-venoso en un caso proteinosis alveolar severa: cinco años de seguimiento

“…Formas severas de proteinosis alveolar, aunque bien descriptas, son infrecuentes 3 . El LPT ha sido bien descripto bajo soporte vital con circulación extracorpórea y más recientemente ECMO 2,5,6 . La decisión de realizar LPT bajo ECMO veno-venoso en lugar de venoarterial puede ser controversial por el potencial fallo del ventrículo derecho, pero en este caso fue bien tolerado.…”

Direct thrombolysis of multiple thrombi in both right and left heart atrium in a patient on extracorporeal membrane oxygenation support following urgent double-lung transplantation: a case report

“… 3 , 4 , 11 ECMO is not able to reverse the poor prognosis in patients who do not qualify for lung transplantation. 11 , 12 Chiumello et al referred, that the report by the United Network of Organ Sharing showed that, despite its complexity and side effects, the use of ECMO as a bridge to lung transplantation has risen by 150% in the last 2 years compared to the previous decades (1970–2010). 3 ECMO is an alternative, rather than an adjunct, to invasive mechanical ventilation and is a better bridging strategy to lung transplantation.…”

“… 3 ECMO is an alternative, rather than an adjunct, to invasive mechanical ventilation and is a better bridging strategy to lung transplantation. 2 , 11 , 12 Extra-corporeal life support as a bridge to lung transplantation is a promising option for patients with end-stage lung disease on the organ transplant waiting list. 13 The shear stress created by the mechanical pumps causes changes in the hemocoagulation system in almost all patients treated with ECMO.…”